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A Voyage to Deliver Medical Care to the World’s Poorest People

The Africa Mercy, owned and run by Mercy Ships, is the world’s largest charitable floating hospital; an accolade it will pass on to the newest member of the Mercy Ships fleet in about 18 months’ time. Currently under construction in China, Mercy Ships’ first ever new build vessel will be double the size of the Africa Mercy once delivered.

Executive Director – Lea Milligan

As life-changing as these floating hospitals are, for Mercy Ships, an organisation that has delivered healthcare to the world’s poorest countries for almost 40 years, the operations carried out on board are but one piece of solving the healthcare puzzle for the world’s poorest countries, most notably in West Africa. Daniel Barnes spoke to Mercy Ships UK’s Executive Director Lea Milligan to find about more about the charity’s incredible work and long-lasting impact.

“Helping nations to understand the healthcare problems in their country, and work with them to strengthen it is a crucial part of our work,” said Lea Milligan, Executive Director of Mercy Ships UK. “If we are going to make a lasting difference - and do ourselves out of a job - we at Mercy Ships believe that the gap that we are filling is one of the key ways towards making that a reality.”

Founded in 1978, Mercy Ships has spent the last four decades delivering holistic healthcare services to the world’s poorest countries, with the charity’s fleet chalking up 581 port stays across countries in dire need of additional healthcare.

Today, operations on board the charity’s one ship - Africa Mercy - are supported by 16 national offices across the world. Stevenage based Mercy Ships UK, celebrating its 20 anniversary last year, has become the largest contributor of funds and volunteers outside the US.

“The conversion of the Africa Mercy into a hospital ship took place here in the UK and it was an extremely proud moment for Mercy Ships UK when she set sail in 2007 to start her first service in West Africa,” smiled Lea, who joined the charity on 1 July 2016, following the retirement of Judy Polkinhorn who led the charity for 12 years.

“Mercy Ships UK has about 20 members of staff and our main remit is to generate resources for the running of the Africa Mercy, to partner with UK-based organisations who can supply medical equipment, drugs or marine equipment - either free of charge or at a discounted rate - and to keep the ship’s operations running as efficiently as possible,” said Lea. “We also support the 120 or so volunteers per year who go out from the UK to crew the ship.

In total the Africa Mercy, which is currently halfway through its ten month stay in Benin before sailing to Cameroon in August, requires around 1,000 volunteers per year. The ship is a 152m 16,572GT former rail ferry, converted into a floating hospital at a cost of £30m. The hospital, located on the old rail deck, contains five operating rooms, a four bed recovery room, intensive care for up to five patients, an 80 bed ward and room for essential supplies and services – all squeezed into 1,200sqm.

On average, it takes over 400 crew members - nurses, doctors, surgeons and other crew members from all over the world - to maintain the ship’s output. These volunteers are the lifeblood of the charity, both figuratively and literally speaking.

“We don’t have a running blood bank aboard the ship, so we regularly ask the crew to donate blood voluntarily to a mobile blood bank,” added Lea.

Smiles from Sambany

Sambany before and after surgery

And without this mobile blood bank, people like Sambany from Madagascar would never have been able to have the life-changing operations on board the ship.

Sambany had a tumour on the right hand side of his face which weighed an astonishing 7.46kg (16.45lb) - a tumour that had been growing for 36 years.

“By the time we saw Sambany, this tumour had become a critical situation,” recalled Lea. “This thing was draining a lot of blood and was right on the limits of what we could possibly do.

“Our American maxillofacial specialist said this procedure was at the edge of his own ability, as he had never dealt with anything so big, whilst our Northern Irish anaesthetist who was tasked with keeping Sambany alive during the operation suggested that this was going to be touch and go for the majority of the six-hour operation.”

Sambany had twice the amount of his own blood transfused through his system during the procedure; blood which came from 17 people from six different nations.

Thankfully, the operation was a huge success and his tumour was completely removed.

“When Sambany walked back to his village, no-one recognised him,” said Lea. “There was an incredible scene in one of the videos post-surgery, when he looks in a mirror, reaches towards his face and his hand stops about eight inches from his face, because that was where the tumour used to be. To see in his eyes just how this adjustment had transformed his life was just amazing.”

In addition to performing over 82,000 life-changing or life-saving operations (regular operations include cleft lip and palate repair, cataract removal and orthopaedic procedures), and getting on for 400,000 dental procedures performed, the charity has trained tens of thousands of local medical professionals and educated over 200,000 local people in basic healthcare.

“The ship carries out about 8,000 dental procedures in its ten month stay at port: that includes everything from cavity extractions, root canals, replacement dentures, and all of the very basic oral healthcare stuff that you and I just take for granted,” added Lea.

A Lasting Legacy

But getting back to the point raised at the beginning of this article, the floating hospital’s ten month port stay is part of Mercy Ships’ holistic five year plan of creating a legacy.

“We have a fairly routine pattern now,” explained Lea. “The first year focuses on political liaison where we work with the national government, the ministry of health and the local healthcare system to map out a plan to determine how we can have the biggest impact. We also partner with as many local organisations as we can.

“In the second year we carry out advanced screening and work alongside local healthcare professionals to identify the surgical cases that we can deal with, and what categories of surgery we are going to be able to support. We then triage the system and help to relieve some of the pressure on the healthcare system, and also build infrastructure for the future.

“In year three, we spend ten months with the ship in that country. We arrive around August and leave again in June. That is how it is with Benin right now; Africa Mercy arrived last August and will leave in June for the shores of Cameroon.

“Having delivered significant amounts of training whilst we have been present in a country, and having renovated spaces on land, in year four we go back and check the fidelity of that training, and that people are still doing what they were trained to do, whilst identifying any areas that need refresher training and providing it where necessary.

We return in year five to do an evaluation, to gauge the impact of what we have achieved. So whilst we are transforming individual lives and making a huge impact, we are also heavily invested in seeing the practice of a nation transformed whilst we are there.”

Madagascar’s WHO Checklist Triumph

The impact of Mercy Ships’ healthcare legacy was brought to the fore by the work the charity recently carried out in Madagascar – the ships’ destination before Benin.

The Mercy Ships Medical Capacity Building program has been working for years to successfully implement the Safe Surgery Saves Lives Surgical Safety Checklist, set out by the World Health Organisation (WHO), in the local hospitals the charity is supporting and working in.

For those of us not familiar with our global healthcare guidelines, the Checklist is a simple tool that helps the surgical team to improve safety in surgery and has been proven to decrease operating room mortality by nearly 50 per cent, as well as significantly decrease surgical complications and infections.

Whilst the only piece of the Checklist that actually costs anything is the use of a pulse oximeter (and the charity has teamed up with the organisation Lifebox to offer this instrument where needed), education and the changing of mind-sets has proven to be a bigger hurdle than the financial cost.

But in Madagascar, after implementing the Checklist in a couple of local hospitals, the country’s government decided to adopt it as common practice and rolled it out across the rest of the country’s entire healthcare system.

New Ship Project

All of this crucial work Mercy Ships is performing will effectively double once the charity’s inaugural new build vessel is completed. Scheduled for delivery in late 2018, the new ship, at 37,000GT, will be twice the size of the Africa Mercy. Under construction at China Shipbuilding Industry Corporation’s (CSIC) Tianjin Xinganag Shipyard, this Deltamarin designed hospital ship is being project managed by Stena RoRo of Gothenburg, Sweden.

Once construction and the subsequent outfitting of all hospital equipment are complete, the ship is expected to be operational within 2019; destined to join the Africa Mercy around the ports of West Africa.

With that in mind, are the fundraising tasks and operational workload faced by Lea at the charity’s UK locale - and his international counterparts the world over – set to double in the upcoming years as Mercy Ships moves from one ship to two?

“It’s almost that simple, except that the new ship is twice as big as the current one, so in reality, it’s closer to 2.5 times operational capacity,” explained Lea. “The expectation for new crew is over 700 positions, which with an average turnaround of three months per position, means we are looking at needing another 2,100 volunteers annually in addition to the 1,200 we already have globally.

“The total running cost will be close to double; we’ve got some economy to scale as running two ships isn’t quite as challenging as running one ship on its own. But generally speaking, twice the revenue, 2.5 times the volunteers, and 2.5 times the output is what we’re looking to achieve.”

Funding Volunteers, Running Costs and Medical Equipment

In terms of the financial figures associated with running an organisation of Mercy Ships’ current size, Lea broke it down into three key areas; volunteers, running costs, and medical equipment.

“If we had to pay all of our volunteers’ salaries for all of their specialisms, the UK volunteers alone would cost £1.8m. All of that is completely free. When you scale it up to the total number of volunteers on board, we are talking about over £18million of free skill coming on to the ship. In addition, these people pay all of their own flights, board and lodgings. They are an incredible bunch of people.

“We then match that with around £18million of running costs; that is everything from the scalpels to keeping the lights on in the ship, and then we match that with cooperate partnerships - donated equipment and drugs.

“The total quantity of free drugs and equipment donated to the ship every year comes to around £10million. From the UK perspective again, last year we had a new machine donated to the ship which takes samples and is able to transmit a live link of those samples back to an oncologist in the UK for instant readings and results. That was donated completely free of charge by an organisation in the UK.”

Mercy Ships UK currently has an annual turnover around the £5million mark. Lea said one of his main remits since joining last year is to more than double the current operational capacity.

“I have come in with the remit of discovering how to get ourselves to that point; how to increase the revenues to make that sustainable, how to increase the donor base, so that we have a more stable platform, and how to find more and more volunteers to staff multiple vessels.”

A daunting prospect, granted, but witnessing the positive, life-transforming impact these results will have on the people currently suffering in West Africa is the main reason why Lea took up his position at Mercy Ships in the first place.

Positively Impacting Others

“I’m hugely passionate about doing something with my career and with my life that ultimately impacts others. Like many of us, I sit behind a desk, take calls and write emails, but at the end of the day, I know that the pictures on my office wall and which surround me are the beneficiaries of that.

“I see each of the individuals whom we help to transform their world as a shareholder of this organisation, and they demand the best of us. They demand that we become more efficient, that we increase the margins, and that we find new and innovative ways to engage volunteers. That is a deep-rooted passion that I’ve found is being satisfied here at Mercy Ships.

Lea said this overarching desire to help those less fortunate permeates through the entirety of the charity’s staff and team of volunteers.

“Seeing a volunteer come back from the ship talking about how they raised their own finances, gave up their career to go out there for three months to work, and say that they have gained more than they gave blows my mind every time.

“Many have come back a different person, who can’t wait to get back out there again. The people we think have given the most are those who feel even more blessed by what they have experienced.”

And as for Lea, he has applied to volunteer for two weeks in November, when the ship will be a few months into its port stay in Cameroon.

“I haven’t yet been told what highly un-skilled task they will be assigning to me, but I am massively excited about going to going to Cameroon; whether I’m washing pots or scrubbing decks, I just want to go out and give a helping hand.”